Advertisement

Hemodynamic changes during balloon-occluded transarterial chemoembolization (B-TACE) of hepatocellular carcinoma observed by contrast-enhanced ultrasound

  • 370 Accesses

  • 3 Citations

Abstract

Balloon-occluded transarterial chemoembolization (B-TACE) is able to achieve denser accumulation of Lipiodol emulsion (LE) in hepatocellular carcinoma (HCC) than conventional TACE. However, to maximize the therapeutic effect of B-TACE, it is imperative to understand the hemodynamic changes that occur during arterial occlusion. We here present two patients with HCC in whom the hemodynamic changes during arterial occlusion were depicted and evaluated by contrast-enhanced ultrasound (CEUS). Arterial flow beyond the catheter tip was observed by CEUS even after balloon occlusion. In one patient, a reduction in arterial blood flow in the HCC was observed by CEUS during balloon occlusion of the target area for embolization. After B-TACE, dense LE accumulation in the HCC nodule was confirmed by flat-panel detector CT, indicating an excellent therapeutic effect. In the other patient, no changes in arterial blood flow in the HCC nodule were observed by CEUS during balloon occlusion of the target area for embolization. After B-TACE, intermediate LE accumulation in the HCC nodule was confirmed by flat-panel detector CT, indicating an incomplete therapeutic effect. The findings obtained in the two patients presented here suggest that B-TACE can be performed more effectively and reliably by monitoring blood flow using CEUS.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. 1.

    Irie T, Kuramochi M, Takahashi N. Dense accumulation of Lipiodol emulsion in hepatocellular carcinoma nodule during selective balloon-occluded transarterial chemoembolization: measurement of balloon-occluded arterial stump pressure. Cardiovasc Interv Radiol. 2013;36:706–13.

  2. 2.

    Cho KJ, Lunderquist A. The peribiliary vascular plexus: the microvascular architecture of the bile duct in the rabbit and in clinical cases. Radiology. 1983;147:357–64.

  3. 3.

    Demachi H, Matsui O, Takashima T. Scanning electron microscopy of intrahepatic microvasculature casts following experimental hepatic artery embolization. Cardiovasc Interv Radiol. 1991;14:158–62.

  4. 4.

    Tohma T, Cho A, Okazumi S, et al. Communicating arcade between the right and left hepatic arteries: evaluation with CT and angiography during temporary balloon occlusion of the right or left hepatic artery. Radiology. 2005;237:361–5.

  5. 5.

    Ekataksin W. The isolated artery: an intrahepatic arterial pathway that can bypass the lobular parenchyma in mammalian livers. Hepatology. 2000;31:269–79.

  6. 6.

    Kita R, Sakamoto A, Nagata Y, Nishijima N, Ikeda A, Matsuo H, et al. Visualization of blood drainage area from hypervascular hepatocellular carcinoma on ultrasonographic images during hepatic arteriogram: comparison with depiction of drainage area on contrast-enhanced ultrasound. Hepatol Res. 2012;42:999–1007.

Download references

Conflict of interest

The authors declare that there are no conflicts of interest.

Ethical standard

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 [5]. Informed consent was obtained from all patients for inclusion in the study.

Author information

Correspondence to Katsutoshi Sugimoto.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (MPG 4998 kb)

Supplementary material 1 (MPG 4998 kb)

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Sugimoto, K., Saguchi, T., Saito, K. et al. Hemodynamic changes during balloon-occluded transarterial chemoembolization (B-TACE) of hepatocellular carcinoma observed by contrast-enhanced ultrasound. J Med Ultrasonics 41, 209–215 (2014) doi:10.1007/s10396-013-0487-7

Download citation

Keywords

  • Hepatocellular carcinoma
  • Balloon-occluded transarterial chemoembolization (B-TACE)
  • Sonazoid
  • Contrast media
  • Ultrasound